Modele 8

Question 1

National Health Service: Health Care System

Answer 1

Universal coverage funded by taxation
*Canada, England

Question 2

Social Insurance: Health Care System

Answer 2

Universal coverage is provided within a social security framework and is funded by employer/individual contributors.
*Germany, Japan

Question 3

Private Insurance: Health Care System

Answer 3

Purchase of private insurance by employers or individuals which is risk oriented.
*US

Question 4

Healthcare systems are funded by one or more of the following 4 methods:

Answer 4

1. Tax revenues
2. Social or state insurance
3. Private insurance
4. Direct payment by users

Question 5

Most modern healthcare systems are facing similar key challanges:

Answer 5

*growing healthcare expenditures of the last 3 decades
*aging populations and changing healthcare needs
*expansion of medical technology and treatments available
*rising public expectations and demands

Question 6

History of Health Care in Canada

Answer 6

*1st major piece of healthcare legislation in Canada was passed in 1947 in Saskatchewan
*current healthcare system is based on the 1984 Canada Health Act

Question 7

Canada Health Act

Answer 7

passed in 1984–established the publicly-funded national health insurance we have today (Medicare)
*The Canada Health Act replaced and consolidated the previous health care acts that were in place across the country

Question 8

Canada Health Act continued

Answer 8

*each province has their own health insurance system which must follow the framework laid out in the Canada Health Act
*requires the provision of all “medically necessary” hospital and physician services
*certain services such as home care, dental care and prescription medications are generally not considered to fall under the definition of “medically necessary”. Therefore, it is generally up to the discretion of the provinces and territories to decide how they are provided.

Question 9

5 Key Canada Health Act Principles

Answer 9

1. Public Administration: requires that provinces and territorial plans must be administered and operated on a non-profit basis by a public authority accountable to the provincial or territorial government.
2. Comprehensiveness: requires that provinces and territorial plans must insure all medically necessary services provided by hospitals, medical practitioners and dentists within a hospital setting.
3. Universality: requires that provinces and territorial plans must entitle all insured persons to health insurance coverage on uniform terms and conditions.
4. Accessibility: requires that provinces and territorial plans must provide all insured persons reasonable access to medically necessary hospital and physician services without financial barriers or other barriers.
5. Portability: requires that the plans must cover all insured persons when they move to another province or territory and when they travel abroad–some limits on services provided outside of Canada.

Question 10

The federal governments role in Healthcare

Answer 10

Responsible for:
setting and administering national principles, funding, and providing services to special populations (e.g. Veterans, Aboriginal Populations, etc), protection and regulation and public health.

Question 11

The health care system in Canada is strongly influenced by the:

Answer 11

Biomedical model

Question 12

Biomedicalization of Aging:

Answer 12

refers to the view that aging and related illnesses are “medical problems” to be treated by medical means. Increasingly older adults are being referred to specialized medical care, offered intensive services and receiving care in the hospital. The biomedical orientation of the health care system is increasingly being recognized as not the most appropriate for meeting the needs of older adults.

Question 13

Health Care Funding

Answer 13

health care system is financed primarily through tax revenue. Funding is provided to provinces/territories through Canada Health Transfers. Provinces also contribute to funding through taxes and fees. Services that are not insured publicly may be paid for by private insurance or out-of-pocket payments

Question 14

In 2016 11.1 % of Canada’s GDP was spent on healthcare

Answer 14

approx 6300/person with a total of 228 billion:
1) hospitals
2) drugs
3) physicians

Question 15

Acute Care:

Answer 15

hospitals, emergency care, day surgeries, etc
*Hospitals account for the largest share of healthcare spending in Canada. Since the mid 1980s the # of hospital beds has been declining as a part of a broad trend of deinstitutionalization. Major concerns for this sector include wait times and alternate level of care patients.

Question 16

Primary Care:

Answer 16

General practitioners, mental health care, health promotion, nutrition, etc.
*use of physician services has increased over the past two decades and primary care physicians act as ‘gatekeepers’ to the rest of the healthcare system (referrals). Increasingly older adults are being referred by GP’s to specialists for care.
*Primary care has been an important priority for Canada since 2000. Reforms in primary care have focused on: developing interprofessional teams/group practices, new payment schemes for physicians, primary healthcare governance systems, developing of electronic medical records, and increasing the # of primary healthcare providers and improving training.

Question 17

Alternative level of Care:

Answer 17

refers to patients who are occupying hospital beds but do not require this level of care. These patients are primarily seniors awaiting discharge to residential care or the community.

Question 18

Long-Term Care (also known as home or community care)

Answer 18

not considered “medically necessary” services and therefore are not included under the umbrella of Medicare in Canada. As a result, there is a mix of public, non-profit, and private delivery of long-term care services. Long-term care tends to rely strongly on informal care provided by family members and friends. Long-term care and costs of this care are often seen as the responsibility of the individual and their family

Question 19

3 Types of Long-tern Care

Answer 19

1) Long-term residential: majority of public funding goes towards providing long-term care in nursing homes + other types of residential care facilities
2) Home Care services: personal, supportive and therapuedic services are delivered in the home or community through home care
3) Self and informal care: Large amounts of long-term care in the community continue to be provided by the individual or informally by family or friends.
*in recent years, health care systems have become interested in shifting care from hospitals and long-term residential care to community settings, and in particular increasing the delivery of care in the home via home care services

Question 20

Impacts of Population Aging:

Answer 20

pop. aging is expected to result in increased pressures on health care system due to:
* increasing life expectancy
* large proportion of older adults living with chronic conditions (approx. 3/4 of older adults have a chronic condition and 1/4 have 3 or more chronic conditions)
* 40% of acute hospital stays are by older adults
* 95% of people in residential care and 82% of home care clients are older adults
* approx. 2/3 of older adults use 5 or more prescription meds.
*Generally research and data suggests that pop. aging will not bankrupt our health care system. However, and aging pop., increased life expectancy, and increased burden of chronic diseases means that health care needs are shifting and there is greater need for complex and long-term health care.

Question 21

Pharmaceuticals and New Technologies

Answer 21

have been identified as emerging contributors to the increases in health care costs. New technology can include the introduction of new products (including pharmaceuticals or techniques. Techniques that prevent diseases often pay off in the long-term, however, technologies that treat symptoms usually actually increase costs.
* in 2016 we spent more on pharmaceuticals than physician care. Evidence suggests that some drugs are being inappropriately prescribed and over-prescribed
*Introduction of new generics and generic pricing policies have contributed to some reductions in cost, but spending on pharmaceuticals remain an important concern.

Question 22

Privatization:

Answer 22

Normally refers to increased control and involvement by private groups. In terms of health care systems, privatization may mean delivery of services by private providers, increased reliance on family and non-profits to provide care, provision of health services as market goods, and payment of services out-of pocket. In Canada, private providers of health care are not necessarily the concern, rather it is viewing health care as a profit-making business (profitization). A hollowing out of Medicare has occurred with services being removed from the public realm and put into the private realm.

Question 23

When problems arise in the Canada healthcare system, privatization of health care services is often proposed as a potential “solution”
Myths:

Answer 23

Myth #1) A parallel for-profit system would reduce waiting times
*would actually only offer faster care only for those who can afford it–limited health care personnel
Myth #2) Private for-profit systems would provide better quality care at a lower cost
*has been wildly unsuccessful in the U.S. –leads to perverse behaviours like fraud, over-billing etc.
Myth #3) Health care systems should be run on market principles
*health care violates basic market principles–monopolies exist, insurance decrease incentives to economize